NIOSH 1986 Sep; :689-690
The features required for a detection program for early cancer are described with regard to lung carcinoma. Requirements for screening include a high prevalence of detectable preclinical disease in a target population, an effective treatment regime, and a high degree of specificity. The benefits of screening have been assessed by changes in morbidity and mortality. The author notes that case survival assessment necessitates correction factors for specific biases including lead time and length biases and selection and observation biases. Clinical trials in lung cancer screening have shown that chest radiographs are more sensitive than sputum cytology, but even radiography has a low sensitivity of 24 to 82 percent. Sputum cytology is slightly more specific than chest x- ray. The author notes that chest radiographs are of greater value in the detection of peripheral tumors while sputum cytology identifies radiographically occult central or hilar malignancies. Studies using both radiography and sputum cytology have shown that more lung cancers are discovered in screened populations, that screen detected neoplasms have a larger shift to early stage tumors, and that case survival increases in screen detected malignancies. However, no clinical trial has yet demonstrated a reduction in mortality. The author concludes that resources should only be committed to large scale routine screening for lung cancer with caution.
Diagnostic-tests; Lung-cancer; Clinical-diagnosis; X-ray-diagnosis; Cytopathology; Epidemiology; Pulmonary-system-disorders; Medical-screening
Book or book chapter
Foa-V; Emmett-EA; Maroni-M; Colombi-A
Occupational Respiratory Diseases. J. A. Merchant, Editor; Division of Respiratory Disease Studies, Appalachian Laboratory for Occupational Safety and Health, NIOSH, U.S. Department of Health and Human Services, DHHS (NIOSH) Publication No. 86-102